Pain up to the hollow of the knee
Leg Many patients experience pain in the calf area, especially during physical activity. However, there are also diseases that typically lead to pain at rest. A possible cause of calf pain, which can occur both at rest and during exercise, is so-called “phlebothrombosis” (deep vein thrombosis, thrombosis in the leg).
This term is used to describe a disease that is caused by the occlusion of deep leg veins by a blood clot. In patients suffering from deep leg vein thrombosis, there is a risk that the blood clot will suddenly dissolve and travel with the bloodstream to the lungs or other organs. As a result, a life-threatening pulmonary embolism can develop, for example.
The thrombosis in deep leg veins, which can lead to pain in the calf, is provoked by the interaction of various factors (so-called Virchow triad). A pronounced slowing down of the blood flow plays a decisive role in this context. Especially long bending of the knee joints (e.g. on long-distance flights) can significantly reduce the blood flow.
In addition, a lack of blood circulation after surgery can significantly increase the risk of developing leg vein thrombosis with pain at rest that occurs in the calf area. Further risk factors are changes in the blood composition and changes or damage to the vascular walls. In addition to the pain in the calf, which can also occur at rest, the typical symptoms of leg vein thrombosis include increased venous drawing, overheating of the affected leg, taut shiny skin, calf pressure pain (Lowenberg’s sign), pain in the calf when stretching the foot (Hohmann’s sign) and sole pain when pressing on the inner sole of the foot (Payr’s sign).
In addition, affected patients may develop a fever and show elevated levels of inflammation in the blood. The treatment of deep vein thrombosis, which can also lead to pain in the calf when at rest, usually involves three important goals. Both the spread of the blood clot and its carry-over, as well as the restoration of the original blood flow are among the most important treatment goals.
A further cause of calf pain, which is also evident at rest, is calf cramps. In calf cramps there is an involuntary tension (contraction) of individual muscles or entire muscle groups in the lower leg. In most cases, it is precisely in stressful situations that a calf cramp develops.
However, people often report that they are awakened at night by a calf cramp that occurs at rest. Typically, the pain caused by a calf cramp is so severe that the sleeper is unable to rest for a while. In addition, the acute hardening of the affected muscles is one of the typical symptoms of a calf cramp.
In most cases, the calf cramp is the cause of pain in the calf, even when at rest, and is often caused by a harmless disturbance in the electrolyte balance. These electrolyte shifts are due, for example, to underlying diseases that lead to an increased electrolyte loss. Classical examples of such diseases are acute diarrhea, vomiting, diabetes insipidus and chronic inflammatory bowel disease.
In addition, various drugs (e.g. diuretics) can lead to a pronounced electrolyte deficiency. Above all, a lack of magnesium can provoke a muscle cramp, which also leads to pain in the calf when at rest. In addition to the occurrence of muscle cramps, severe headaches, general weakness, fatigue and cold feet are indications of a magnesium deficiency.
Furthermore, overstraining during the day can also lead to cramps at rest. Older people are much more susceptible to the occurrence of calf cramps. The reason for this is the fact that the musculature becomes increasingly shorter as we age.
Regulation disorders of the cardiovascular system, on the other hand, typically lead to pain in the calf, which increases under stress and decreases significantly at rest. Pain in the calf, which occurs particularly after jogging, is usually caused by overstraining the calf muscles. The calf muscles are exposed to a great deal of strain when running and can react with painful tension or signs of fatigue.Sometimes the shoes are also the cause of the pain, if they are not suitable for jogging or are not optimally adapted to the runner.
Poor running techniques with resulting incorrect weight bearing can also trigger the pain. Foot malpositions that have not been corrected appropriately by orthopedic insoles can also put a lot of strain on the calf muscles when running. Optimal footwear is therefore essential for every runner and should definitely be purchased to prevent additional signs of wear in the joints.
The cartilage in the knee joint is also permanently damaged by incorrect loading. In many of the patients affected, the pain in the calf area occurs mainly when walking or running. In some cases, these complaints persist even at rest, but increase significantly in intensity when walking or running.
One of the most common causes of calf pain when walking or running is muscle injury (e.g. pulled muscles or torn muscle fibers). The term “pulled muscle” (technical term: distension) is understood in medical terminology to mean the process of stretching a muscle beyond its normal extent. Simple muscle strains must be distinguished from a torn muscle fibre, as the extent of the injury is much more pronounced in the case of a torn muscle fibre.
In contrast to the uncomplicated muscle strain, the presence of a ruptured muscle fiber can be demonstrated by clear structural changes that lead to the destruction of some muscle cells as well as to local bleeding into the muscle tissue. A torn muscle fiber is one of the most common sports injuries. In terms of symptoms, however, the two clinical pictures are very similar.
The typical symptoms of both muscle strain and rupture are a sudden, strong pain in the calf area that increases significantly in intensity when walking or running. In addition, the mobility of the affected body part is significantly restricted immediately after the muscle injury has occurred. In addition, local bruising and bruising can cause pain in the calf, which increases in intensity when walking or running.
Such lesions are often sports injuries, popularly known as horse kisses. In some cases, patients suffering from pain in the calf have a significantly increased risk of a heart attack due to the cause. In this context, especially pain in the calf, which occurs when walking or running and subsides again when at rest, indicates a circulatory disorder (arteriosclerosis).
Furthermore, an inflammation of the superficial leg veins can lead to chronic pain in the calf area, which limits the affected person, especially when walking or running. There can be various causes for the development of pain in the calf, which occurs mainly at night. Many patients who feel pain in the calf at night suffer from the so-called “restless legs syndrome” (synonym: restless legs, Wittmaack-Ekbom syndrome).
This clinical picture is a neurological disorder which is mainly characterized by sensory disturbances and a pronounced urge to move in the calves and feet. In addition, many of the affected patients suffer from pain in the calves and involuntary movements (twitching). Occasionally, a similar clinical picture can also be observed in the area of the arms.
Restless Legs Syndrome causes strong pulling in the calves and feet, especially in states of rest, for example at night. In addition, the majority of affected patients report a pronounced feeling of tension, tingling and pain. The symptoms caused by the neurological disorder trigger an irresistible urge to move, as the tensing and stretching of the calf muscles at least temporarily relieves the symptoms.
Although the symptoms typical of restless legs syndrome can occur at any time of the day, most patients report that the symptoms are worse in the evening or at night than during the day. A typical characteristic of restless legs syndrome is the immediate relief of symptoms by moving the affected limb. Especially slow walking around, knee bends and periodic tensing of the calf muscles can help to relieve the symptoms.
The pain in the calf caused by this disease can have a negative effect on sleep at night.The sleep rhythm of affected patients can be disturbed to such an extent that they suffer from increasing tiredness, exhaustion and exhaustion during the day. In this way, the restless legs syndrome and the associated complaints at night can also have a lasting effect on the psyche of those affected. The cause for the development of this disease could not be clarified lastingly until today.
One assumes however that the neurotransmitter Dopamin plays a crucial role in the disease development. The treatment of restless legs syndrome is primarily based on the subjective suffering of those affected. Since the symptoms, which occur mainly at night, can cause a pronounced lack of sleep and thus cause psychological suffering (e.g. depression), restless legs syndrome should be treated early on. Possible forms of treatment range from the oral substitution of iron preparations, the administration of highly potent painkillers to the intake of synthetic messenger substances. Levodopa, a precursor of dopamine, is particularly suitable for the treatment of restless legs syndrome.
